MELBOURNE, AUSTRALIA – While doctors have focused on respiratory samples from pneumonia cases to identify coronavirus patients, they might have ignored a less apparent source of the spread: diarrhea.

The novel coronavirus was detected in the loose stool of the first U.S. case — a finding that hasn’t featured among case reports from Wuhan, China, the epicenter of the outbreak. However, that doesn’t surprise scientists who have studied coronaviruses, nor doctors familiar with the bug that caused SARS.

Diarrhea occurred in about 10 to 20 percent of patients afflicted with severe acute respiratory syndrome about 17 years ago and was the source of an explosive SARS outbreak in the Amoy Gardens residential complex in Hong Kong.

SARS and Wuhan viruses bind to the same distinctly shaped protein receptors in the body that are expressed in the lungs and intestines, making these organs the primary targets for both viruses, said Fang Li, an associate professor of veterinary and biomedical sciences at the University of Minnesota.

The discovery of the Wuhan virus, dubbed 2019-nCoV, in the fecal material of the 35-year-old man treated at the Providence Regional Medical Center Everett in Washington is “interesting,” said Scott Lindquist, the state epidemiologist for infectious disease at Washington’s Department of Health.

“That adds to the knowledge about this,” he told reporters on a conference call Friday. “It’s not only excreted in your respiratory secretions, it’s also secreted in your stool.”

Researchers don’t yet know how exactly 2019-nCoV spreads from person to person, but they suspect it is most likely from coming into contact with virus-containing droplets that could be emitted by an infected person’s cough and transferred to their hands or surfaces and objects.

That has led to a run on face masks. But those may be of limited benefit in the event the virus is being transmitted via the fecal-oral route, said John Nicholls, a clinical professor of pathology at the University of Hong Kong.

Squat latrines lacking covers, common in China, and hands that aren’t washed thoroughly with soap and water after visiting the bathroom could be a source of virus transmission, said Nicholls, who was part of the research team that isolated and characterized the SARS virus.

A virus-laden aerosol plume emanating from a SARS patient with diarrhea was implicated in possibly hundreds of cases at the Amoy Gardens housing complex in 2003. That led Hong Kong researchers to understand the importance of the virus’s spread through the gastrointestinal tract and to recognize both the limitation of face masks and importance of cleanliness and hygiene, Nicholls said in an interview.

“I think in Wuhan, that would be a very likely place where you might get the transmission” from fecal material, he said. “If it’s using the same receptor as for SARS, I can’t see why it shouldn’t be replicating in the gut.”

Nicholls and colleagues at the University of Hong Kong are testing laboratory models of human tissues and specimens to understand where and how the Wuhan virus replicates, he said.

Doctors have reported diarrhea infrequently in 2019-nCoV patients admitted to Wuhan hospitals, though it has been more prominent among reported cases outside the city, including members of a Shenzhen family infected in Wuhan, and more recently in the first U.S. case in Washington state. That patient experienced a two-day bout of diarrhea from which a sample tested positive.

The lab in Washington didn’t attempt to grow the virus from that specimen, said Lindquist, “because it wasn’t going to add anything to his care.”

Many of the emerging coronaviruses are so-called pneumoenteric viruses, meaning they can replicate both in the respiratory tract and the gastrointestinal system, said Ralph Baric, professor of microbiology and immunology at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, who has studied coronaviruses for decades.

Overwhelmed by hundreds of severely sick pneumonia patients, doctors in Wuhan might not have focused on any gastric signs, Baric said in a phone interview.

“The Chinese are so overwhelmed at the moment and trying to do a combination of treating patients and dealing with the scope of the outbreak, and then trying to get out papers that describe what’s happening,” he said.

Any virus in stool is more likely to be present during the acute phase of an infection, occurring before hospitalized patients develop a life-threatening complication known as acute respiratory distress syndrome, Baric said.

“I have also spent most of my time focusing on the respiratory tract symptomology rather than the gut because of the relationship between these different emerging viruses and acute respiratory distress syndrome,” he said.

Zijian Feng, deputy director general of Chinese Center for Disease Control and Prevention, and colleagues released a report Wednesday on the first 425 Wuhan cases, and noted that early infections that didn’t appear to display typical signs — such as fever and viral pneumonia — or had mild symptoms might have been missed.

“The initial focus of case detection was on patients with pneumonia, but we now understand that some patients can present with gastrointestinal symptoms,” Feng and co-authors said in their report, which was published in the New England Journal of Medicine.

Emerging evidence of virus-containing diarrhea warrants further investigation, said Peter Collignon, a professor of clinical medicine at the Australian National University Medical School in Canberra, who advises the Australian government on infection control.

“This is something new,” Collignon said in an interview. “We presume it’s respiratory droplets, but with SARS there was evidence of other routes. We have to keep an open mind.”

My flights to/from Singapore were awesome...soo empty! 90% of the people there were wearing pointless masks...and panic sets in when they need to remove them and touch their thumbs for the passport checks.

matsuki wrote:My flights to/from Singapore were awesome...soo empty! 90% of the people there were wearing pointless masks...and panic sets in when they need to remove them and touch their thumbs for the passport checks.

I guess flight tickets are pretty cheap right now.

Hotels are also a buy.

This year I reserved a room for two in Shikoku for 8000 Yen, whereas last year the same room went for more than twice that.

― Voltaire“To learn who rules over you, simply find out who you are not allowed to criticize.”

“I know not with what weapons World War III will be fought, but World War IV will be fought with sticks and stones.” ― Albert Einstein

Hmm, this starts to look like a conspiracy to me. How about this: The CIA let the corona virus loose in Wuhan in order to hamper the trade from China to the west. Now Trump can confidently state that he won the trade war and will easily win the elections.

The bummer is that if this turned out to be true, I guess that no-one really would be muchly surprised, let alone shocked. That's how deep we sank aready.

BREAKING: 44 more people on the Diamond Princess cruise ship have tested positive for coronavirus: Japan's health minister japantimes.co.jp {The number of newly-found infected rose from 39 to 44 in the past few hours.}

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Grumpy Gramps wrote:Hmm, this starts to look like a conspiracy to me. How about this: The CIA let the corona virus loose in Wuhan in order to hamper the trade from China to the west. Now Trump can confidently state that he won the trade war and will easily win the elections.

The bummer is that if this turned out to be true, I guess that no-one really would be muchly surprised, let alone shocked. That's how deep we sank aready.

Like the conspiracies about it being a man made bio-weapon, would be a failure. The only places it's deadly are where the health care systems suck.

Chinese tourist areas in particular but judging by the "why worry? Japan safety cuntry" mentality of the idiots I've seen not washing their hands in restrooms this week, it's bound to spread. Mask up but don't wash their hands? The veneer of looking responsible while being reckless is beyond me. I keep going back to it but it reminds me of the idea that sunglasses are viewed as "accessories" and not professional while Japan has the worst eyesight in the world and is getting worse....what was that about science and facts?

Chinese tourist areas in particular but judging by the "why worry? Japan safety cuntry" mentality of the idiots I've seen not washing their hands in restrooms this week, it's bound to spread. Mask up but don't wash their hands? The veneer of looking responsible while being reckless is beyond me. I keep going back to it but it reminds me of the idea that sunglasses are viewed as "accessories" and not professional while Japan has the worst eyesight in the world and is getting worse....what was that about science and facts?

Since there is no clear known path via which the Wakayama surgeon got infected, Wifey theorized that he probably got it from a Chinese hooker. Probably not far from the truth...

― Voltaire“To learn who rules over you, simply find out who you are not allowed to criticize.”

“I know not with what weapons World War III will be fought, but World War IV will be fought with sticks and stones.” ― Albert Einstein

Today at COSTCO's. Got myself a shopping trolley and there comes a girl, who sprayed and wiped down the handle of the trolley with alcohol. Thank you, nice service that I would appreciate also without any virus.

Grumpy Gramps wrote:COSTCO's... girl, who sprayed and wiped down the handle of the trolley with alcohol. Thank you, nice service...

Another nice service is that at Kawasaki COSTCO nearly all employees speak English and/or Spanish. I always do a double-take when the totally Japanese looking 三世 Peruvian or a Filipina cashier calls me "sir."

Diamond Princess is COVID-19 mill. How I got in the ship and was removed from it within one day.

Diamond Princess has completely inadequate infection control, and there is no professional ID person in charge. Passengers, crews, health care professionals working inside are at risk of infection, and the practice is even worse than what I saw in Africa. Immediate action is needed to save people inside.

OK, looks like this thing is totally out of control.

― Voltaire“To learn who rules over you, simply find out who you are not allowed to criticize.”

“I know not with what weapons World War III will be fought, but World War IV will be fought with sticks and stones.” ― Albert Einstein

A Japanese infectious disease specialist has castigated his government's handling of quarantine on a coronavirus-stricken cruise ship, saying it was run by "bureaucrats" who stoked the crisis by failing to follow basic protocols.

On Wednesday, Japanese authorities announced 79 more cases, bringing the total of infected cases on the ship to 621.

Kentaro Iwata of Kobe University Hospital took his criticism to YouTube after he spent a day as a volunteer doctor on the Diamond Princess. The luxury liner has become an incubator for the novel coronavirus, with more than 600 people now infected.

The ship docked in Yokohama on Feb 3. Japan has been criticized for its handling of the quarantine, including by the U.S. Centers for Disease Control and Prevention (CDC).

But Iwata's criticism is some of the most scathing yet.

"The cruise ship was completely inadequate in terms of the infection control," he said in his video. "There was no single professional infection control person inside the ship and there was nobody in charge of infection prevention as a professional. The bureaucrats were in charge of everything."

His English and Japanese language videos criticizing what he saw inside have been seen more than 1 million times and forced a response from the government.

When asked about the videos and the criticism, the government's top spokesman, Yoshihide Suga, said staff on the boat were thoroughly protected from infection through the use of masks and hand washing. The government has repeatedly defended its measures as appropriate.

Iwata said in the videos that he volunteered to help out in the quarantine but was taken aback at what he saw inside. Against protocols that he'd followed in fighting Ebola, SARS, and cholera, there was no distinction between a green zone, which is free of infection, and a red zone, which is potentially contaminated by virus, he said.

He relayed his concerns to officials on the boat and was later told to leave the site, he said.

Iwata told Reuters that he could face professional repercussions for his public rebuke of the government. He said he posted the videos at the urging of his wife, who is also an infectious disease specialist and said it was his professional duty to get the word out.

"You don't want to hide the chaotic problem and risk to lots of people," Iwata said. "You have to really do something about it."